A nurse is providing dietary teaching to a client who has hypocalcemia due to hypoparathyroidism. Which of the following foods should the nurse recommend? (Select all that apply.)

Choice A reason:

The client reports increased thirst. This is not an indication that the medication was effective, because increased thirst can be a sign of dehydration or electrolyte imbalance caused by excessive diuresis. Furosemide can cause loss of water and sodium, potassium, calcium, magnesium, and chloride in the urine.

Choice B reason:

The client's urine output is 250 mL/hr. This is an indication that the medication was effective, because furosemide is a loop diuretic that inhibits the reabsorption of sodium and water in the ascending limb of the loop of Henle, resulting in increased urine output and decreased fluid volume. A normal urine output is about 30 to 60 mL/hr, so a urine output of 250 mL/hr indicates a significant diuretic effect.

Choice C reason:

The client's heart rate is 100/min. This is not an indication that the medication was effective, because a high heart rate can be a sign of hypovolemia, hypotension, or cardiac stress caused by furosemide. Furosemide can lower the blood pressure and reduce the preload and afterload on the heart, but it can also trigger compensatory mechanisms such as increased sympathetic activity and renin-angiotensin-aldosterone system activation, which can increase the heart rate.

Choice D reason:

The client's weight is unchanged. This is not an indication that the medication was effective, because weight loss is expected with furosemide therapy due to fluid removal. Furosemide can cause a rapid and significant reduction in fluid volume, which can be measured by daily weight changes. A weight loss of 1 kg corresponds to a fluid loss of about 1 L.

Choice A reason:

Kussmaul respirations are a type of deep, rapid breathing that occurs in response to metabolic acidosis. The body tries to compensate for the excess acid by blowing off carbon dioxide through the lungs. Kussmaul respirations are a common manifestation of diabetic ketoacidosis (DKA), which is a severe form of metabolic acidosis caused by the accumulation of ketones in the blood. The nurse should monitor the client's respiratory rate, depth, and pattern, as well as the arterial blood gas results, to assess the severity of metabolic acidosis and the effectiveness of treatment.

Choice B reason:

Bradypnea is a condition of abnormally slow breathing, usually less than 12 breaths per minute. Bradypnea can result from respiratory acidosis, which is a condition of excess carbon dioxide in the blood due to hypoventilation or impaired gas exchange. Bradypnea is not a manifestation of metabolic acidosis, which is a condition of excess acid in the blood due to increased production or decreased elimination of hydrogen ions. Therefore, choice B is incorrect.

Choice C reason:

Muscle spasms are involuntary contractions of the skeletal muscles that can cause pain and discomfort. Muscle spasms can result from hypocalcemia, which is a condition of low calcium levels in the blood. Hypocalcemia can occur in metabolic acidosis due to the binding of calcium with excess hydrogen ions, reducing the availability of free calcium for muscle contraction. However, muscle spasms are not a specific or common manifestation of metabolic acidosis, and they can have other causes such as dehydration, electrolyte imbalance, or muscle injury. Therefore, choice C is incorrect.

Choice D reason:

Numbness and tingling of extremities are sensations of reduced or abnormal feeling in the arms or legs. Numbness and tingling can result from hypokalemia, which is a condition of low potassium levels in the blood. Hypokalemia can occur in metabolic acidosis due to the movement of potassium from the intracellular to the extracellular space in exchange for hydrogen ions, which are then excreted by the kidneys. However, numbness and tingling are not specific or common manifestations of metabolic acidosis, and they can have other causes such as nerve compression, peripheral neuropathy, or hyperventilation. Therefore, choice D is incorrect.